Healthcare Provider Details

I. General information

NPI: 1023076486
Provider Name (Legal Business Name): DAVID H. MRUZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 WADE HAMPTON BLVD
TAYLORS SC
29687-2716
US

IV. Provider business mailing address

3014 WADE HAMPTON BLVD
TAYLORS SC
29687-2716
US

V. Phone/Fax

Practice location:
  • Phone: 864-292-6777
  • Fax: 864-292-5392
Mailing address:
  • Phone: 864-292-6777
  • Fax: 864-292-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number832
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: